Nearly 72 million individuals were enrolled in Medicaid and CHIP in June 2015. This enrollment count is point-in-time (on the last day of the month) and includes all enrollees in the Medicaid and CHIP programs who are receiving a comprehensive benefit package.

292,112 additional people were enrolled in June 2015 as compared to May 2015 in the 51 states that reported comparable May and April 2015 data.

Looking at the additional enrollment since October 2013 when the initial Marketplace open enrollment period began, among the 49 states reporting both May 2015 enrollment data and data from July-September of 2013, nearly 13.1 million additional individuals are enrolled in Medicaid and CHIP as of June 2015, almost a 22.7 percent increase over the average monthly enrollment for July through September of 2013. (Connecticut and Maine are not included in this count.)

This is a huge story which I should have been following, but a) I was on vacation the past couple of weeks, b) I can't cover everything healthcare-related, and c) it's really not directly related to the Affordable Care Act. Fortunately, the Arkansas Times' David Ramsey has been all over it, so I'll let him lay it out for you:

...all three members of the household were among almost 36,000 Arkansans who were kicked off of their health coverage on July 31. Insurance for another 13,000 people across the state will terminate at the end of this month. The cancellations are the result of a statewide sweep of Medicaid performed by the Arkansas Department of Human Services in an attempt to weed out those beneficiaries whose incomes are too high.

Last week I estimated the overall weighted average rate increases for the Arkansas individual market at "between 4-5%", with a rough estimate of around 4.6%.

Today, Arkansas Times reporter David Ramsey has provided the exact market share numbers for Arkansas. When I plug these in, the weighted average comes in a bit higher, at 4.98%:

HOWEVER, according to Ramsey, the Arkansas Insurance Division says that the actual weighted average is only 4.4% overall.

There could be any number of reasons for the discrepancy; it's possible that there's a few additional minor off-exchange carriers who I've missed, or there could be rounding errors/etc. In any event, these are all just estimates anyway, so I'll go with AID's official 4.4% figure.

Nevada's insurance dept. rate filing website has an extremely user-friendly, interactive website which lets you drill down and find exactly what you're looking for: Individual or Small Group policies, HMO or PPO, Under Review or Reviewed. From what I can tell, there are 12 companies offering individual policies in 2016 (a 13th, the Nevada Health COOP, just announced that they've gone belly-up and are being dissolved, meaning a minimum of 16,000 Nevadans will have to switch to a different insurance carrier).

The requested rates were approved for 8 of the companies, but were reduced significantly for Aetna (from 21-24% down to 15%). Here's what it looks like in the end:

The Small Group market is faring somewhat better, with just a 5.3% overall weighted average increase:

The Washington Health Benefit Exchange and Healthplanfinder, the state’s marketplace and website where people can buy individual and subsidized health insurance under health reform, have gone through some big changes lately.

Most important to consumers, Healthplanfinder is no longer the portal through which customers pay their insurance premiums.

On Tuesday, the organization announced that starting Sept. 24, Qualified Health Plan and Qualified Dental Plan customers will be required to pay their monthly premiums directly to their insurance companies, and the site will no longer accept those payments after Sept. 23.

The change mirrors a stop-gap measure put in place last year after problems plagued the site’s payment mechanism.

Consistent with findings over the past few months, the American public remains divided in their opinion of the health care law; 44 percent say they have a favorable view and 41 percent say they have an unfavorable view. Opinion of the law continues to diverge along party lines, with most Democrats reporting a favorable view of the law (76 percent) and most Republicans reporting an unfavorable view of the law (71 percent). Among independents, 46 percent say they have an unfavorable view, while 39 percent report a favorable view.

When I last checked in on Rhode Island's 2016 rate increase status, the three companies operating in the state (BCBSRI, Neighborhood and UnitedHealthcare) had requested hikes of 7%, 8.6% and 11% respectively. There was no off-exchange enrollment data, but the exchange-based market share breakdown was roughly 48.5% / 48.5% / 3%. This meant a requested average hike of around 7.9%.

Still unresolved is how much Blue Cross and Blue Shield of Rhode Island may raise rates for its individual plans, which cover about 25,000 people. The nonprofit insurer initially requested an 18-percent increase, but no decision has yet been made because, by law, its rate hike requests are reviewed in a separate process that reserves a key role for the state's attorney general.

An Anchorage trial court judge Friday said that Alaska Gov. Bill Walker’s administration can expand the Medicaid health care program starting next week, dismissing a request by the state Legislature to temporarily block enrollment while attorneys fully argue lawmakers’ legal challenge.

In a 45-minute opinion delivered from the bench, Pfiffner rejected a series of arguments by the Legislature that starting expanded Medicaid enrollment Tuesday was so problematic that it should be put on hold while the Legislature’s lawsuit proceeds.

The actual lawsuit will still proceed, but this is still great news for up to 40,000 Alaskans.

Luis Lang, the subject of a May 13 story centering on his struggle to find someone to pay for eye surgery, did not specifically blame President Obama for his inability to get insurance through the Affordable Care Act. He says he blames Washington and state politicians for gaps in the system.

When I last checked in on the ongoing saga between the New Mexico Insurance Commissioner and Blue Cross Blue Shield of New Mexico, BCBS was threatening to take their ball and go home if NM Insurance Commish John Franchini didn't cave and agree to let them jack rates up by 51% on the individual market (Franchini had agreed to a 24% hike instead).

Thousands of New Mexicans will need to shop for new health insurance plans later this year after a decision by Blue Cross Blue Shield to stop offering individual insurance plans through the state health exchange beginning Jan. 1.

...The letter said Blue Cross Blue Shield of New Mexico lost $19.2 million in 2015 on the 35,000 individuals covered by plans they purchased on and off the exchange.

...Blue Cross will offer a basic-level insurance plan outside the exchange in 2016, which will be available to all consumers at the same rate as in 2015.

The new rates will affect about 300,000 people who buy health insurance on their own or work for small businesses with 50 or fewer employees and will renew plans in January.

...The rate hikes approved by the state mean that premiums for individuals and small businesses will rise 6.3 percent next year, on average, but the costs for some plans will rise more, and others less. This year, rates for individuals and small employers rose an average of 3.1 percent in January, after increasing 1.9 percent in 2014.

When I posted Maryland's July enrollment update, I noted that the effectuated exchange-based QHP number had actually gone up slightly from April through July (from 125,535 to 126,346). Not much of an increase, of course, but the fact that this number increased at all was significant since it indicated that, as I expected, new additions to the exchange QHP pool thanks to the "life event" options are slightly outpacing those dropping their policies during the off-season.

Blue Cross of Idaho’s rates for individuals buying their own plans will go up an average of 23 percent. Company officials say the increase is needed after Blue Cross lost millions of dollars because current customer premiums are not keeping up with claims paid.

Last year, the company’s average rate increase for individual policies was about 15 percent. That year, the company paid nearly $221.1 million in claims while receiving $188.7 in premiums.

Other average rate changes for 2016, including for plans sold off the Idaho health insurance exchange:

Mountain Health COOP: 26 percent

SelectHealth: 15 percent

Regence BlueShield of Idaho: 10 percent

BridgeSpan Health, a sister company of Regence: 7 percent

PacificSource Health Plans: -8 percent

State Insurance Director Dean Cameron said he did not find any proposed rate changes to be unreasonable.

JUNEAU — The state Division of Insurance has approved average rate increases for next year of nearly 40 percent for the two companies providing individual health insurance plans through the federally run online marketplace.

Division director Lori Wing-Heier says Premera Blue Cross Blue Shield and Moda Health cited the high cost of medical services as one of the factors in requesting rate increases.

She also said Alaska has a relatively small market and very small group of individuals with high-cost claims.

She said the average rate increase approved for Premera was 38.7 percent and 39.6 percent for Moda. She said that applies to individual plans on and off the online marketplace.

Wing-Heier says the cost of health care in Alaska has been a long-standing concern, with no clear answers for addressing it.

Well I'll be damned. Given all the tea leaf/entrail-reading that I've had to do in some states to try and piece together the weighted average rate increases for 2016 (usually due to missing enrollment/market share data for the companies participating), it's a pleasant surprise to see that my own state of Michigan has posted the approved rate hikes without any gobbledygook:

Individual market to increase on average 6.5%, small group 1.0%

FOR IMMEDIATE RELEASE - August 18, 2015

LANSING - Michigan consumers and small businesses will experience lower increases in the cost of their 2016 health insurance plan than those in many other states, according to the Michigan Department of Insurance and Financial Services (DIFS). DIFS reports that the average approved rate changes on a premium weighted basis increased by 6.5 percent for the individual market and 1 percent for the small group market.

OLYMPIA, Wash. –The Office of the Insurance Commissioner has approved 136 individual health plans from 12 insurers who will offer them to the Exchange, Wahealthplanfinder, for sale in 2016. The Washington Health Benefit Exchange Board is scheduled to certify the approved insurers and their plans at its board meeting later today.

The companies requested an average rate change of 5.4 percent, but 4.2 percent was approved.

Yes, I'm back. From what I can tell, the major Obamacare/health insurance-related stories while I was out were a) Scott Walker/Marco Rubio finally releasing their proposed "replacement plans" (such as they are) for the ACA, and b) the approved 2016 rate changes for ACA-compliant individual/small group policies across a whole mess of states (technically all 50 states +DC had to be finalized as of 2 days ago, but it'll still take awhile to dig up all of them, since many news stories & reports may leave out off-exchange plans, increases of less than 10% and/or actual market share for weighting purposes).

I'm ignoring the Walker/Rubio story for the moment, mainly because they're both complete jokes, but will write up something about that later. For now, let's dive into the approved 2016 rate change story, starting with Arkansas.

If some major development occurs I'll post it (and I'll probably be posting links to stuff via Twitter and Facebook here and there), but otherwise don't expect much in the way of site updates until next Thursday.

UPDATE: Yeah, yeah, I saw the news about both Rubio and Walker releasing their "Obamacare Replacement Plans". As far as I can tell, they're both the same warmed-over crap that the GOP has been farting around with for 5 years now, a mish-mash of "Obamacare without the Obama part", with "selling across state lines" added and "regulations requiring insurance companies not to act like complete jerkfaces" removed. I'll probably write up something about it when I get back next week, but that's my initial reaction.

When Attkisson posted her phantom numbers, one of the biggest ways she came up with her phony tally of how many people have gained healthcare coverage was to simply ignore Medicaid expansion completely. Apparently Medicaid "doesn't count" as healthcare coverage for some reason or another (or perhaps it's the other way around: To conservatives, anyone who qualifies for Medicaid apparently "doesn't count" as a human being). As a result, she was able to lop off about 6.1 million newly enrolled Medicaid recipients at the time (this is now up to perhaps 10 million newly covered out of the 14.5 million or so who've been added to the Medicaid rolls since the ACA was enacted).

Vermont was one of the earliest states to report their requested rate hikes back in mid-May. Due to Vermont's small size (both in total population as well as insurance providers...there's only two of them even operating on the individual markets), as well as their unique law requiring that all individual policies be purchased through the ACA exchange, they were also one of the easiest to calculate.

In addition, as far as I can tell, in Vermont, both the individual and small group markets are considered part of the same rate pool, although the market share differences between the two still resulted in slightly different weighted averages: 7.8% for the individual market, 8.1% for the small group market. These were slightly revised to 8.0% and 8.3% just prior to the review/approval process.

The next open enrollment period for Marketplace coverage begins on November 1, 2015 for coverage starting on January 1, 2016. Some people can sign up for health coverage outside of open enrollment, before November 1, because they qualify for a special enrollment period (SEP). A consumer can qualify for a SEP for such circumstances as loss of health coverage, losing Medicaid eligibility, changes in family status (for example, marriage or birth of a child), or other exceptional circumstances.

This snapshot provides information about consumers who selected a plan between February 23 and June 30, 2015 through the HealthCare.gov platform, which includes 37 states with Federally Facilitated Marketplaces, State Partnership Marketplaces, and supported State-Based Marketplaces.

Assuming my ballpark estimate of appx. 7,500 Off-Season QHP Selections Per Day is accurate, the grand total nationally should be breaking the 13 million milestone right about...now-ish (or at least sometime this week).

YES, I KNOW ABOUT THE BIG CMS OFF-SEASON QHP REPORT released a couple of hours ago, and I'll be posting about that next, but I just got back from an end-of-summer camp carnival thing with my kid, and want to make sure I get Massachusetts crossed off the list first.

The Massachusetts Health Connector just held their monthly board meeting this morning, and have released the July dashboard report with a whole mess of demographic data for Baystate-obsessed nerds to revel in.

I've pasted screen shots of every page of the report below (and there's a link to the PDF version above), but here's the main takeaways:

Effectuated QHPs have reached 170.5K...a whopping 45,161 higher than at the end of Open Enrollment!

While the national effectuation number is likely only 2% or so higher today than it was in March (likely 10.4 million vs. 10.2 million), in Massachusetts it's 36% higher. There's two main reasons for this, both connected to "ConnectorCare", which is unique to Massachusetts. ConnectorCare consists of the same low-end Qualified Health Plans that anyone can purchase (ie, they're still counted as QHPs in the national tally), except that in addition to the federal Advanced Premium Tax Credits (APTC), enrollees in ConnectorCare also receive additional state-based financial assistance, making them even more attractive to enrollees. In addition, however, unlike "normal" APTC or Full Price QHPs, which are limited to the official open enrollment period for most people, ConnectorCare enrollment, like Medicaid/CHIP, is open year round. That makes a dramatic difference, as you can see below; over 85% of the net QHP enrollment increase since March is thanks to ConnectorCare additions.

In addition, MA is the only state I know of which actively reports their attrition numbers--that is, so far this year they've had just 16,631 people drop their QHP policies, meaning a total of 187,194 people have selected a plan and paid at least their first monthly premium.

Assuming a 90% payment rate (confirmed for Massachusetts back in April), this also suggests that the cumulative QHP selection total should be roughly 208,000 people to date, which is only significant to me and The Graph.

But wait, there's more! Look below and you'll see a whole mess of pie charts, bar charts and line charts, breaking out everything from Metal Level selections and Market Share by Provider to SHOP enrollments (5,302 lives covered as of August 1st) and even Dental Plans!

IMPORTANT:See this detailed explanation of how I've come up with the following estimated maximum requested weighted average rate increases for this state.

As explained in the first link above, I've still been able to piece together rough estimates of the low, mid-range and maximum possiblerequestedaverage rate increase for the Arkansas individual market. Note: While the table & methodology for Arkansas are the same as most of the other states I've posted on, there's one important difference here; see below for details:

Health and Human Services Secretary Sylvia M. Burwell announced today $169 million in Affordable Care Act funding to 266 new health center sites in 46 states, the District of Columbia and Puerto Rico for the delivery of comprehensive primary health care services in communities that need them most. These new health center sites are projected to increase access to health care services for over 1.2 million patients. These awards build on the $101 million awarded to 164 new health center sites in May 2015.

IMPORTANT:See this detailed explanation of how I've come up with the following estimated maximum requested weighted average rate increases for this state.

As explained in the first link above, I've still been able to piece together rough estimates of the maximum possible and mid-range requested average rate increase for the Ohio individual market:

Again, the full explanation is included here, but to the best of my knowledge, it looks like the companies with rate increases higher than 10% come in at a weighted 15.5% increase, but only make up about 28% of the total ACA-compliant individual market, with several other companies with requested increases of less than 10% (decreases in some cases) making up the other 72%.

Then, a few days later, the New Mexico state insurance commissioner announced the approved rate hikes for all 5 (or is it 6? see below...) of the companies in question. For BCBSNM (aka HCSC), they lopped the 57% hike down massively:

IMPORTANT:See this detailed explanation of how I've come up with the following estimated maximum requested weighted average rate increases for this state.

As explained in the first link above, I've still been able to piece together rough estimates of the maximum possible and mid-range requested average rate increase for the Georgia individual market:

Again, the full explanation is included here, but to the best of my knowledge, it looks like the companies with rate increases higher than 10% come in at a weighted 18.3% increase, but only make up about 29% of the total ACA-compliant individual market, with several other companies with requested increases of less than 10% (decreases in some cases) making up the other 71%.

The Alabama House of Representatives on Wednesday narrowly approved a deep cut to the state's Medicaid program as lawmakers continue to deadlock on a solution to the budget shortfall.

The budget cut came out of frustration over the stalemate and is largely seen as a way to build pressure on lawmakers to find some sort of compromise. But opponents called it a dangerous gamble with the health care of the state's most vulnerable people.

Rebecca Santiago clutched a stack of papers about Obamacare and chatted up strangers at the health fair, set up on a Hartford street within view of two homeless shelters. She wanted to know if they had health insurance and, perhaps more importantly, if they’d used it.

One was Darin Zollarcoffer, 48. He had coverage, but no primary care doctor.

IMPORTANT:See this detailed explanation of how I've come up with the following estimated maximum requested weighted average rate increases for this state.

As explained in the first link above, I've still been able to piece together rough estimates of the maximum possible and mid-range requested average rate increase for the North Carolina individual market:

While their reports have always been comprehensive, they were also a bit confusing. Thankfully, starting with their June report, they've made the appropriate data points a bit more obvious. While the QHP selection total is still confusing, the effectuated number (which is really more relevant at this point is the combination of APTC/CSR + non-APTC/CSR enrollees, or 74,583 + 59,617 = 134,200 people as of the end of June.

WASHINGTON, D.C. -- Arkansas and Kentucky continue to have the sharpest reductions in their uninsured rates since the healthcare law took effect at the beginning of 2014. Oregon, Rhode Island and Washington join them as states that have at least a 10-percentage-point reduction in uninsured rates.

IMPORTANT:See this detailed explanation of how I've come up with the following estimated maximum requested weighted average rate increases for this state.

As explained in the first link above, I've still been able to piece together rough estimates of the maximum possible and most likely requested average rate increase for the state's individual market:

As noted in the table, the Arizona analysis is even more fuzzy than most other states, because the enrollment/market share estimate for Health Net is a guess. According to their Q2 2015 SEC filing (page 49), Health Net had 69,000 people enrolled in individual policies in Arizona as of 6/30/15. They don't break out grandfathered/transitional policies (I'm assuming about 14% combined), nor do they provide a PPO/HMO split, so I'm just going with 50/50, or 60K total ACA-compliant enrollees.

Not much of a headline, I realize, but I wasn't really sure how else to put it. Thanks to R. Adams Dudley for the link.

JAMA (Journal of the American Medical Association) just reported a study regarding the impact of the ACA on insurance coverage, access to care and health. Not much for me to add here; most of it has been widely reported by many outlets, including myself, but it's always good to have more supporting evidence of results, especially given the massive sample size (over half a million people!). I've reformatted & cleaned up the quoted section below for clarity, and you'd have to log into a JAMA account for the full report, but this gives the general skinny:

Results:

Among the 507 055 adults in this survey, pre-ACA trends were significantly worsening for all outcomes. Compared with the pre-ACA trends, by the first quarter of 2015, the adjusted proportions who were:

The challenge concerns the Origination Clause, which provides that “[a]ll Bills for raising Revenue shall originate in the House of Representatives; but the Senate may propose or concur with Amendments as on other Bills.” The original idea was to give control over the power to raise revenue to the House, which was thought to be more directly accountable to the people than the Senate, whose members were then selected by state legislatures.

Ten Republican presidential hopefuls took to the debate stage last night to prove their conservative bona fides. They swore they'd unravel President Barack Obama's legacy. But there was one place they barely went: repealing Obamacare.

IMPORTANT:See this detailed explanation of how I've come up with the following estimated maximum requested weighted average rate increases for New Mexico.

As explained in the first link above, I've still been able to piece together rough estimates of the maximum possible and most likely requested average rate increase for the New Mexico individual market:

Again, the full explanation is included in the Missouri estimate linked at the top of this entry, but to the best of my knowledge, it looks like the companies with rate increases higher than 10% come in at a weighted 43.3% increase, but only make up about 62% of the total ACA-compliant individual market, with several other companies with approved increases of less than 10% (decreases in some cases) making up the other 38%.

IMPORTANT:See this detailed explanation of how I've come up with the following estimated maximum requested weighted average rate increases for Illinois

As explained in the first link above, I've still been able to piece together rough estimates of the maximum possible and most likely approved average rate increase for the Illinois individual market:

Again, the full explanation is included in the Missouri estimate linked at the top of this entry, but to the best of my knowledge, it looks like the companies with rate increases higher than 10% come in at a weighted 32.7% increase, but only make up about 57% of the total ACA-compliant individual market, with several other companies with approved increases of less than 10% (decreases in some cases) making up the other 43%.

Fortunately, as I explain in the first link above, I've still been able to piece together rough estimates of the maximum possible and most likely approved average rate increase for the Kentucky individual market:

IMPORTANT:See this detailed explanation of how I've come up with the following estimated maximum weighted average rate increase request for New Jersey

Assuming you've read through the explanation linked to above, here's my best estimate of the maximum possible and most likely average rate increase requests for the New Jersey individual market:

Again, the full explanation is included in the Missouri estimate, but to the best of my knowledge, it looks like the companies requesting rate increases higher than 10% come in at a weighted 13.4% increase, but only make up about 50% of the total ACA-compliant individual market, with several other companies (Oscar, AmeriHealth & possibly other off-exchange only companies) requesting increases of less than 10% (or possibly even decreases in some cases) and making up the other half.

Now that the Supreme Court has rendered its decision in King v. Burwell on federal subsidies under the Affordable Care Act (ACA) and Open Enrollment is approaching, there is no better time to reflect on the important mission of access to affordable and quality health coverage for the residents of all states. Health insurance is complex; it engages a range of stakeholders from state agencies and insurance carriers to brokers and solution providers, it requires eligibility determination, various payment models, and a myriad of funding mechanisms, to name a few.

In order to do this properly, I'd need 2 pieces of data: First, the weighted average increase request for the 6 additionalcompanies which I didn't already have rate requests for; and second, the total ACA-compliant enrollment number for those 6 companies.

During the fiscal year that ended June 30, 2014, the most recent for which data is available, Planned Parenthood affiliates around the country received $528.4 million in government funds (a combination of state, federal and sometimes local government dollars), according to the organization's ownannual report and information it's required to share with the IRS.

Last week, CBO provided the following information in response to a request for an estimate of the budgetary effects of S. 1881:

S. 1881, which would prohibit federal funds from being made available to Planned Parenthood Federation of America or any of its affiliates, could affect direct spending for the Medicaid program; however, CBO has not determined whether the legislation would increase or decrease the program’s spending. Completing an estimate of such effects would take some time.

MAYAGÜEZ, P.R. — The first visible sign that the health care system in Puerto Rico was seriously in trouble was when a steady stream of doctors — more than 3,000 in five years — began to leave the island for more lucrative, less stressful jobs on the mainland.

Now, as Puerto Rico faces another hefty cut to a popular Medicareprogram and grapples with an alarming shortage of Medicaid funds, its health care system is headed for an all-out crisis, which could further undermine the island’s gutted economy.

I've mused before about how Avik Roy has a tendency to write lengthy screeds which breathlessly report developments which seem, to him, to be shocking revelations which will no doubt blow the lid off of some sort of nefarious actions on the part of President Obama, the HHS Dept. or Democrats in general...but which, when looked at by a rational person, tend to be fairly innocuous developments which were either already known, patently obvious and/or pretty much non-events in the scheme of things.

For instance, check out this blockbuster from back in March, regarding the HHS Dept's contingency plan in the event that the Obama administration had lost the King v. Burwell case at the Supreme Court (spoiler: they ended up winning):

If you ask most people what the earliest utterly absurd plot point in the original Star Wars​ movie ("A New Hope", 1977) was, they'd probably say the part about 7 minutes in where Gunnery Captain Bolvan tells Lieutenant Hija (yeah, I looked up their names) to "hold his fire" and not to bother shooting down the escape pod containing R2-D2 and C-3PO, because there were "no life forms onboard" (an odd thing to say in a universe filled with sentient robots...not to mention that Leia could have simply stowed the records on a hard drive or whatever and tossed it into the escape pod by itself for future recovery, but whatever).